NHS Continuing Healthcare is a package of free healthcare for individuals who have significant and ongoing needs. It is not means-tested which means that it does not matter what your income is or the level of your savings, if you meet the criteria, you are eligible.
Towards the end of last year, the Department of Health and Social Care revised the National Framework for Continuing Healthcare to provide greater clarity to clinical commissioning groups (CCGs) and local authorities and reflect the implementation of the Care Act 2014.
But what exactly are the changes and how do they work in practice?
Essentially, the five main revisions are as follows:
- The new Framework makes it clear that the eligibility criteria must be applied equally to everyone, regardless of where they receive care. This is welcome news for patients whose care needs are met in their own home.
- The Guidance sets out that Continuing Healthcare assessment can take place outside of acute hospital settings. This should reduce unnecessary stays in hospital. Further guidance is provided about the circumstances in which patients don’t need to be reviewed in order to cut down on inessential assessments.
- Clarification that the main purpose of three- and 12-month reviews is to review the suitability of the care package, rather than reassess patients’ eligibility. In fact, eligibility should only be reviewed if the CCG can demonstrate that the patient’s needs have significantly changed. Again, this should reduce unnecessary re-assessments.
- Introduction of new principles for CCGs on the local resolution process when individuals request a review of an eligibility decision. The new Framework sets out details of the two-step local resolution procedure which includes an informal discussion followed by a formal meeting, if required. The aim of this change is to resolve issues as quickly and consistently as possible.
- Additional guidance on the application of the Mental Capacity Act 2005 (MCA) at different stages in the assessment process. It also stipulates that all staff involved in Continuing Healthcare assessments are trained in the principles of the MCA.
Associate solicitor Tom Hall says: “When it was announced that NHS Continuing Healthcare was changing, there was lots of speculation about what the amendments would be and the extent of the changes. The reality is that not a huge amount has changed; although the new Framework does signify a very welcome tightening-up and clarification of the Continuing Healthcare assessment process.
“That said there has been some criticism levelled at legislators that the new guidance falls short of bringing clarity to the complexity surrounding decision-making for each patient’s eligibility for funding. In essence, the assessment process remains highly subjective as the framework is open to interpretation resulting in inconsistencies throughout the regions.”